Notice of Privacy
Practices
THE
ORTHOPEDIC GROUP, P.C.
NOTICE OF PRIVACY
PRACTICES
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW TO GET ACCESS TO THIS
INFORMATION.
PLEASE READ IT CAREFULLY.
THIS
NOTICE IS EFFECTIVE ON AND AFTER APRIL 14, 2003.
If
you have any questions regarding this notice, you may contact our privacy
officer at:
The Orthopedic Group, P.C.
Privacy
Officer, Suite 109, 575 Coal Valley Road, Clairton, PA 15022
Telephone:
412-469-3387
Facsimile: 412-469-4041
I.
YOUR PROTECTED HEALTH INFORMATION.
We,
“The Orthopedic Group, P.C.” are required by state and federal rules
to maintain the privacy of health information and to provide you with
notice of our legal duties and privacy practices with respect to your
protected health care information. We
are required to abide by the terms of the notice currently in effect.
This
notice applies to all records of your care created or received at The
Orthopedic Group’s offices. This
notice also covers those physicians, healthcare providers, and independent
contractors that provide service at our offices.
The Orthopedic Group and such individual will share protected
health information for the treatment, payment and healthcare operations
described in this notice.
Generally
speaking, your protected health information is any information that
relates to your past, present or future physical or mental health or
condition, the provision of health care to you, or payment for health care
provided to you, and individually identifies you or reasonably can be used
to identify you.
Your
medical and billing records at our practice are examples of information
that usually will be regarded as your protected health information.
II.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
This
section describes how we may use and disclose your protected health
information for treatment, payment, and health care operations purposes.
The descriptions include examples.
Not every possible use or disclosure for treatment, payment, and
health care operations purposes will be listed.
A.
Treatment, payment, and health care operations
1.
Treatment-
We may use and disclose your protected health information for our
treatment purposes as well as the treatment purposes of other health care
providers. Treatment includes
the provision, coordination, or management of health care services to you
by one or more health care providers.
Some examples of treatment uses and disclosures include:
·
During
an office visit, practice physicians and our staff involved your care may
review your medical record and share and discuss your medical information
with each other.
·
We may
share and discuss your medical information with an outside physician or
health care facility to whom we have referred you for care or whom we are
consulting regarding your care. (i.e. home health agency, laboratory,
radiology center, durable medical equipment or hospital where we are
admitting or treating you.
·
We may
contact you to provide appointment reminders.
2.
Payment-
We may use and disclose your protected health information for our payment
purposes as well as the payment purposes of other health care providers
and health plans. This
includes activities conducted to obtain payment for the care provided to
you or so that you can obtain reimbursement for that care, for example,
from your health insurer. When
you come to our offices, we will obtain your consent for these types of
payment disclosures. Some
examples of payment uses and disclosures include:
·
Sharing
information with your health insurer to determine whether you are eligible
for coverage or whether proposed treatment is a covered service or for
submission of a claim form, or support the medical necessity of a health
service.
·
Sharing
your demographic information (i.e. your address) with other health care
providers who seek this information to obtain payment for health care
services provided to you.
·
Providing
information to a collection agency or our attorney for purposes of
securing payment of a delinquent account.
3.
Health
care operations-We
may use and disclose your protected health information for our health care
operation purposes as well as certain health care operation purposes of
other health care providers and health plans, if they have or had a
relationship with you. Some
examples of health care operation purposes include:
·
Reviewing
the competence, qualifications, quality assessment, or performance of
health care professionals.
·
Conducting
training programs for medical and other students.
·
Conducting
other medical review, legal services, auditing functions, business
planning and development.
·
Health
care fraud and abuse detection and compliance programs.
·
Other
business management and general administrative activities, such as
compliance with the federal privacy rule and resolution of patient
grievances.
B.
Uses and disclosures for other purposes
We
may use and disclose your protected health information for other purposes.
Possible reasons for such disclosures are described in general
category below. Not every use
or disclosure in a category will be listed as an example.
Some examples may fall into more than one category.
1.
Required
by law- We
may use and disclose protected health information when required by
federal, state, or local law. For
example, we may disclose protected health information to comply with
mandatory reporting requirements involving births and deaths, child abuse,
disease prevention and control, vaccine-related injuries, medical
device-related deaths and serious injuries, gunshot and other injuries by
a deadly weapon or criminal act, driving impairments, and blood alcohol
testing.
2.
Individuals
involved in care or payment for care-
We may disclose your protected health information to someone involved in
your care or payment for your care, such as a spouse, a family member, or
close friend, in less you tell us in advance not to.
For example, if you have surgery, we may discuss your physical
limitations with a family member assisting in your post-operative care.
3.
Notification
purposes-
We may use and disclose your protected health information to notify, or to
assist in the notification of, a family member, a personal representative,
or another person responsible for your care, regarding a your location,
general condition, or death, in less you tell us in advance not to.
For example, if you are hospitalized, we may notify a family member
of the hospital and your general condition.
In addition, we may disclose your protected health information to a
disaster relief entity, such as the Red Cross, so that it can notify a
family member, a personal representative, or another person involved in
your care regarding your location, general condition, or death.
4.
Other
public health activities-We
may use and disclose protected health information for public health
activities, including:
·
Public
health reporting, for example, communicable disease reports.
·
Child
abuse and neglect reports.
·
FDA-related
reports and disclosures, for example, adverse event reports.
·
Public
health warnings to third parties at risk of a communicable disease or
condition.
·
OSHA
requirements for workplace surveillance and injury reports.
5.
Health
oversight activities- We
may use and disclose protected health information for purposes of health
oversight activities authorized by law.
These activities could include audits, inspections, investigations,
licensure actions, and legal proceedings.
For example, we may comply with a Drug Enforcement Agency
inspection.
6.
Victims
of abuse, neglect or domestic violence- We
may use and disclose protected health information for purposes of
reporting abuse, neglect or domestic violence in addition to child abuse,
for example, reports of elder abuse to the Department of Aging or abuse of
a nursing home patient to the Department of Public Welfare.
7.
Judicial
and administrative proceedings- We
may use or disclose protected health information in judicial or
administrative proceedings in response to a valid court or administrative
order. We may also use or
disclose your protected health information in response to a subpoena,
discovery request, or other lawful process. We would only disclose this information if efforts have been
made to tell you about the request or if there is a qualified protective
order protecting the information requested.
8.
Law
enforcement purposes- We
may use and disclose protected health information for certain law
enforcement purposes including to:
·
Comply
with legal process, for example, a search warrant.
·
Report a
crime in an emergency or on the premises.
·
Respond
to a request for information about a crime victim.
·
Report a
death suspected to have resulted from criminal activity.
·
Comply
with a legal requirement, for example, mandatory reporting of gun shot
wounds.
9.
Funeral
Directors, Medical Examiners and Coroners- We
may use and disclose protected health information for purposes of
providing information to a funeral director, coroner or medical examiner
for the purpose of identifying a deceased patient, determining a cause of
death, or facilitating their performance of other duties required by law.
10.
Organ
and tissue donation- For purposes of facilitating organ, eye and
tissue donation and transplantation, we may use protected health
information and disclose protected health information to entities engaged
in the procurement, banking, or transplantation of cadaver organs, eyes,
or tissue.
11.
Workers’
compensation and similar programs- We
may use and disclose protected health information as authorized by and to
the extent necessary to comply with laws relating to workers’
compensation or similar programs, established by law, that provide
benefits for work-related injuries or illness without regard to fault.
For example, this would include submitting a claim for payment to
your employer’s workers’ compensation carrier if we treat you for a
work injury.
12.
Business
associates- Certain
functions of our practice are performed
by
business associate such as a billing company, an accountant firm, or a law
firm. We may disclose
protected health information to our business associates and allow them to
create and receive protected health information on our behalf.
To protect your health information, we require our business
associates to sign a contract that states they will appropriately
safeguard your protected health information.
For example, we may share with our billing company information
regarding your care and payment for your care so that the company can file
health insurance claims and bill you or another responsible party.
13.
Threat to public safety- We
may use and disclose protected health information for purposes involving a
threat to public safety, including protection of a third party from harm
and identification and apprehension of a criminal.
For example, in certain circumstances, we are required by law to
disclose information to protect someone from imminent serious harm.
14.
Specialized
government functions- We may use and disclose protected health
information for purposes involving specialized government functions
including:
·
Protective
services for the President and others.
·
National
security, intelligence, military or veterans activity.
·
Correctional
institutions and other law enforcement custodial situations.
15.
Creation of de-identified
information- We may use protected health information about you in the
process of de-identifying the information. For example, we may use your protected health information in
the process of removing those aspects that could identify you so that the
information can be disclosed to a researcher without your authorization.
16.
Incidental disclosures- We
may disclose protected health information as by-product of an otherwise
permitted use or disclosure. For
example, other patients may overhear your name being paged in the waiting
room.
17.
Specifically approved
research- We may disclose your protected health information to
researchers when an Institutional Review Board or Privacy Board has
reviewed the research proposal, has established appropriate protocols to
ensure the privacy of your protected health information, and has approved
the research.
C.
Uses and disclosures with authorization
For
all other purposes that do not fall under a category listed under above,
we will obtain your written authorization under federal law or your
consent under state law to use or disclose your protected health
information. You may always refuse to sign an authorization or consent,
and neither treatment, payment enrollment, nor eligibility for benefits
will be conditioned upon you providing or refusing to provide such
authorization or consent. Your
authorization can be revoked at any time except to the extent that we have
relied on the authorization. Some
typical disclosures that require your consent or authorization are as
follows:
1.
HIV-related information- We will disclose confidential
HIV-related information about you only in accordance with state law.
Generally, state law requires that confidential HIV-related
information may only be released to whom you specify in a written consent
or to those persons specified by state law who may receive the information
without your consent.
2.
Research- Unless we receive specific approval from an
Institutional Review Board or Privacy Board, we may disclose your
protected health information only after you have signed a written
authorization.
3.
Marketing- We may ask you to sign an authorization allowing us
to use or disclose your health information in order to contact you as part
of a marketing effort. As
part of our marketing, we may tell you about health-related products or
services that may be of interest to you.
III.
PATIENT PRIVACY RIGHTS
You
have the following rights with regards to your protected health
information. If you have any
questions regarding how you may exercise your health information rights,
please contact our Privacy Officer.
For
all other purposes that do not fall under a category listed under sections
III.A and III.B, we will obtain your written authorization to use or
disclose your protected health information.
Your authorization can be revoked at any time except to the extent
that we have relied on the authorization.
A.
Further restriction on use or disclosure- You
have a right to request that we further restrict use and disclosure of
your protected health information (i) to carry out treatment, payment, or
health care operations, (ii) to someone who is involved in their care or
the payment for your care, or (iii) for notification purposes.
We are not required to agree to a request for a further restriction.
If
we do agree, we will comply with your request unless the information is
needed to provide you with emergency treatment or for certain other uses
and disclosures permitted by law.
To request a further restriction, you must complete a separate request form and submit it to our privacy officer. The request must tell us: (a) what information you want restricted; (b) how you want the information restricted; and (c) to whom you want the restriction to apply.
B.
Confidential communication- You
have a right to request that we communicate your protected health
information to you by a certain means or at a certain location.
For example, you might request that we only contact you by mail or
at work. We are not required to
agree to requests for confidential communications that are unreasonable.
To make a request for confidential communications, you must submit a written request to our privacy officer. The request must tell us how or where you want to be contacted. In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled.
C.
Accounting
of disclosures- You
have a right to obtain, upon request, an “accounting” of certain
disclosures of your protected health information by us (or a business
associate for us). This right
is limited to disclosures within six years of the request, may not be for
disclosure before April 14, 2003 and is subject to other limitations.
Also in limited circumstances we may charge you for providing the
accounting. To request an
accounting, you must submit a written request to our privacy officer.
The request should designate the applicable time period.
D.
Inspection
and copying- You
have a right to inspect and obtain a copy of your protected health
information that we maintain in a designated records set.
This right is subject to limitations and we may impose charge for
the labor and supplies involved in providing copies.
To exercise your right of access, you must submit a written request to our privacy officer. The request must: (a) describe the health information to which access is requested, (b) state how you want to access the information, such as inspection, pick-up of copy, mailing of copy, (c) specify any requested form or format, such as paper copy or an electronic means, and (d) include the mailing address, if applicable.
E.
Right
to amendment-
You have a right to request that we amend protected health information
that we maintain about you in a designated records set if the information
is incorrect or incomplete. This right is subject to limitations. To request an amendment, you must submit a written request to
our privacy officer. The
request must specify each change that the you want and provide a reason to
support each requested change.
F.
Paper
copy of privacy notice- You
have a right to receive, upon request, a paper copy of our Notice of
Privacy Practices. To obtain a paper copy, contact our privacy officer.
IV.
CHANGES TO THIS NOTICE
We
reserve the right to change this notice at any time.
We further reserve the right to make any change effective for all
protected health information that we maintain at the time of the change
– including information that we created or received prior to the
effective date of the change.
We
will post a copy of our current notice in the waiting rooms of our
offices. At any time,
patients may review the current notice by contacting our privacy officer. Patients also may access the current notice at our web site at
www.TheOrthopedicGroup.com.
V.
COMPLAINTS
If
you believe that we have violated your privacy rights, you may submit a
complaint to our practice or the Secretary of Health and Human Services.
To file a complaint with our practice, submit the complaint in
writing to our privacy officer. We
will not retaliate against you for filing a complaint.
VI.
LEGAL EFFECT OF THIS NOTICE
This
notice is not intended to create contractual or other rights independent
of those created in the federal privacy rule.